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UWorld FACTOIDs > Labs-Findings 2 > Flashcards

Labs-Findings 2 Flashcards

1
Q

Patient with primary mineralocorticoid exess would have the following serum lab values for sodium, potassium, and bicarbonate?

A

Sodium is normal (aldosterone escape - ANP compensates allowing sodium loss) LOW potasium (due to high aldo) and HIGH BICARB (alkalosis, to secrete hydrogen, bicarb must be reabsorbed?)

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1
Q

Biopsy of breast revelas Solid sheets of pleomorphic, high-grade cells with central necrosis

A

DCIS (comedocarcinoma)

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2
Q

Biopsy of breast revelals increased cytological atypia and stromal cellularity and overgrowth with “leaflike” architecture

A

Phyllodes tumor

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3
Q

Harsh, crescendo-decresendo systolic ejection murmur at right sternal border radiating to carotids

A

AORTIC STENOSIS - BICUSPID AORTIC VALVE is a COMMON CAUSE

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4
Q

Cell body rounding, peripheral displacement of nuclei and dispersion of Nissl substance to periphery of cells of anterior horn of spinal cord

A

AXONAL REACTION - changes in body of neuron after axon is severed. Reflects increased protein synthesis that facilitates axon repair. Visible within 24-48 hours and maximal change at 12 days post injury. Wallerian degeneration.

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5
Q

HUS causes these findings

A

Microangiopathic hemolytic anemia and THROMBOCYTOPENIA - reduced Hb, Ht, RBC count and increased LDH, reticulocytes, Bleeding time increased due to LOSS OF PLATELETS

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6
Q

Large spherule filled with small round endospores found in tissue samples (PIC)

A

Coccidioides immitis

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7
Q

Pulsus paradoxis

A

CARDIAC TAMPONADE - decrease in systolic pressure of 10 mmHg during inspiration compared with pressure during exhalation. (mechanism - pericardial pressure exceeds 10 mmH increasing venous pressure and causes atria to collapse -> reducing ventricular prel

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8
Q

Pulsus parvus et tardus

A

pulse palpaed in patients with AORTIC STENOSIS. Low magnitude with a delayed peak

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9
Q

Amniotic fluid reveals elevatd AFP and acetylcholinesterase

A

NTDs - neural tube fails to fuse causing persistent communication between spinal canala nad amniotic cavity - fetal cerebrospinal fluid leaks out.

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10
Q

Janeway lesions

A

Small, erythematous, hemorrhagic macules appear on soles of feet and hnads, caused by SEPTIC MICROEMBOLI to CUTANEOUS BLOOD VESSELS. Fragements of infected intracardiac vegetations

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11
Q

AFP secreted by these tumors

A

fetal liver and yolk sac normally ,but tumors HCC, nonsemiomatous testiular carcinomas and ovarian carcinomas

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12
Q

You suspect Hypertrophic cardiomyopathy (HCM) how would you enhance this murmur?

A

DECREASE LV END DIASTOLIC VOLUME will increase the obstruction and cause SYSTOLIC EJECTION MURMOR to increase. STAND SUDDENLY from supine and VALSALVA decrease venous return and would accentuate murmor

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13
Q

Maneuvers to increase venticular preload

A

Squatt, sitting, lying supine, passive leg raising increase right and left ventricular preload.

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14
Q

Histological finding in Hashimoto’s thyroiditis

A

Mononuclear, parenchymal infiltration with well-developed germinal centers (Type IV hypersensitivity)

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15
Q

Histology seen in subacute thyroiditis

A

Gde Qervain’s thyroiditis or granulomatous thyroiditis shows MIXED cellular infiltration with occasional multinuclear giant cells.

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16
Q

Serum sodium and urine osmolality after dehydration in DI

A

Urine osmolality 142 mEq/L

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17
Q

Normal urine osmolality after dehydration in healthy individual

A

>800 mOsm/L

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18
Q

Patient undergoes water deprivation test and urine osmolality increases to >500 mOsm/L with serum sodium <10% increase. Diagnosis

A

Primary Polydipsia

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19
Q

Expectorant shows tall, columnar cells that line alveolar septa without evidence of vascular or stromal invation. Lungs show pneumonia-like consolidation

A

bronchioloalveolar carcinoma

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20
Q

Small chain dextrin-like material accumulates within the cytosol of hepatocyte

A

Cori disease (debrnaching enzyme deficiency) alpha-1,6 glucosidic branch points can’t degratde, present with hypoglycemia, hypertriglyceridemia, ketoacidosis, hepatomegaly

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21
Q

Urine of patient in DKA would show a pH, bicarb, and phosphate levels of?

A

Kidneys try to correct via EXCESS H IONS EXCRETED (low pH) CYCLE BICARB (low in urine, releases H+ in exchange for sodium), TITRATABLE ACIDS EXCRETED - binds to HPO4 and NH3 so HPO4 increases

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22
Q

Used as a marker for mast cell activation

A

TRYPTASE

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23
Q

Hyperparakeratosis, acanthosis, rete ridge elongation, mitotic activity above the epidermal basal cell layer, reduced or absent stratum granulosum.

A

Psoriasis (caused by CD4+ T cells that activate CD8+ T cells in epidermis after interacting with APCs in skin)

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24
Q

Thoracocentesis should be performed above these locations

A

ABOVE 7th rib in midclavicular line, 9th rib along midaxillary line, 11th rib along posterior scapular line. Insertion lower increases risk for penetrating abdominal structures

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25
Q

Insert needle inferior margin of rib may damage this structure

A

NEUROVASCULAR BUNDLE - intecostal vein, artery, and nerve lie in the SUBCOSTAL groove on the LOWER border of the rib. INSERT AT UPPER BORDER

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26
Q

Ability to clot blood plasma distinguishes these species

A

Coagulase test separates Staphylococci into 2 groups: Coagulase positive (S. aureus) and coagulase negative (CNS) including S. epidermidis, S. haemolytius, S. saprophyticus, and 30+ other species

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27
Q

3% hydrogen peroxide differentiates

A

Catalase - Streptococci from Staphylococci

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28
Q

Can staphylococci ferment mannitol?

A

Only S. aureus can ferment mannitol

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29
Q

Common lab finding in SLE (Complete Blood count)

A

Pancytopenia - formation of autoantibodies against RBCs, a type II hypersensitivity

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30
Q

early systolic, high-frequency click over cardiac apex and/or right second interspace

A

Nonstenotic bicuspid aortic valve

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31
Q

Neurons that display signs of irreversible damage during the first 48 hours

A

Red neruons

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32
Q

Mechanism of ischemic infarct of brain at 3-5 days

A

MACROPHAGES (MICROGIA) move to ischemic area and phagocytize framgnets of neurons, myelin, an dnecrotic debris. Cystic space replaces necrosis, astrocytes form glical scar along periphery

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33
Q

Polyribitol phosphate

A

Type B Haemophilus

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34
Q

Raised, reticular cyanotic discoleration consistent with livedo reticularis, P-anca, Foot drop

A

Chrurg-Strauss syndrome (Small vessel vasculitis)

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35
Q

Polyglutamic acid capsule

A

Bacillus Anthracis - the only bacterium with a POLYPEPTIDE CAPSULE (contains D-glutamate)

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36
Q

Mold form contains barrel-shaped arthroconidia

A

Coccidioides immitis

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37
Q

Gram (+), spore forming bacilli and widening of the mediastium

A

Bacillus anthracis with polyglutamic acid capsule

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38
Q

Most sensitive test for iron deficiency anemia

A

Low serum ferritin

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39
Q

Dark, intracellular inclusions that stain with crystal violet

A

Heniz bodies strongly associatd with G6PD deficiency, represent Hb that is denatured/precipitated from oxidative stress

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40
Q

Fractured 12th rib could injure which structure?

A

Left kidney lies immediately deep to the tip of the 12th rib on the left

41
Q

CXR shows unilateral pulmonary opacification and deviation of the mediastinum toward the opacified lung

A

Obstructive lesion of mainstem bronchus can prevent ventilation of entire lung, leading to collapse. Trachea will deviate TOWARDS the OPACIFIED LUNG with VOLUME LOSSS (atelectasis)

42
Q

Direction of trachea

A

TOWARD volume loss (atelectasis) and AWAY from opacified lung with a large pleural effusion.

43
Q

Type of cells observed in infectious mononucleosis?

A

Atypical lymphocytes are activated CD8+ cytotoxic T-lymphocytes. Destroy virally-infected B-lymphocytes

44
Q

RPR or VDRL

A

Screening test for treponema pallidum, confirmatory test is known as FTA-ABS

45
Q

RPR test

A

Rapid plasma reagin tests - detects antibodies to human cellular lipids released into the bloodstream after cell destruction by T. pallidum

46
Q

Cold agglutinins positive

A

MYCOPLASMA infection - patient blood is added to tube pretreate with anticoagulant EDTA and then placed on ice. RBCs agglutinate at low temp and return into suspension when warmed.

47
Q

185 kD glycoprotein that spans the cell membrane with intracellular tyrosine kinase activity

A

HER2/neu oncogene encodes this glycoprotein, member of epidermal growth factor receptors. Overexpression accelerates cell proliferation

48
Q

More than 10% increase in urine osmolality following vasopressin administration during water deprivation test

A

CENTRAL D, if urine osmolality increase above 50%, COMPLETE central DI

49
Q

Most characteristic biochemical feature of Huntington disease

A

Decreased GABA in brain (los of GABA-containing neurons in the striatum)

50
Q

marker of total rate of endogenous beta-ell insulin secretion under steady-state

A

C peptide (beta cell peptidases remove from proinsulin to leave mature insulin - B chain and A chain connected via disulfide bonds)

51
Q

Oral hypoglycemic agent that stimulates insulin release

A

SULFONYLUREAS - ie Glyburide

52
Q

2 oral hypoglycemic agents that inrease the sensitivity of insulin on target issues to insulin

A

Metformin (a biguanide) and rosiglitazone (thiazolidendione)

53
Q

Associations with a positive Coombs test

A

Autoimmune hemolytic anemia that often accompanies SLE, Hodgkin, NH lymphomas, Mycoplasma, infectious mono

54
Q

Increased LDH, increased UCB, MCHC >36 g/dL, pigmented gallstoes, negatvie coombs

A

Positive osmotic fragility test - HEREDITARY SPHEROCYTOSIS

55
Q

Xanthochromia

A

Blood in the CSF, most sensitive test for diagnosing SAH

56
Q

Karyotype of 46XX or 46XY with enlarged edematous villi and trophoblastic proliferation “Bunch of grapes”

A

Complete mole with 15-20% risk of malignant trophoblastic disease

57
Q

Cells scraped from an ulcer base are stained with a solution and demonstrate intranuclear inclusions

A

Tzanck prep using Wright-Giemsa staining of epithelial cells, multinucleated giant cells with intranuclear inclusions suggest HSV or VZV infection

58
Q

Is peripheral edema seen in SIADH

A

NORMAL TOTAL BODY VOLUME (euvolemic hyponatremia) due to suppression of renin-aldosterone axis, casuing low aldosterone causing natriuresis (salt-wasting via urine)

59
Q

Low plasma sodium osmolality, concentrated urine, increased sodium in urine, normal body volume

A

SIADH

60
Q

Serum sodium 120 mEq/L + Urine osmolality 360 mOsm/kg

A

SIADH

61
Q

Serum sodium 120 mEq/L + Urine osmolality <100 mOsm/kg

A

PRIMARY POLYDIPSIA

62
Q

“Satellite phenomenon”

A

H influenzae grow only near beta hemolytic S aureus because they produce the needed X(hematin) and V (NAD+) factors for growth. H. influenza is “blood loving” organism

63
Q

Gout results from deposition of

A

MONOSODIUM URATE in joints and soft tissue - needle-shaped and negatively birefringent

64
Q

Mid-diastolic rumble hear best at apex, scattered cells within mucopolysacchride stroma, abnormal blood vessels, hemorrhaging

A

ATRIAL MYXOMA - mos common primary cardiac neoplasm

65
Q

4 year old with 5 day fever, n/v, bilateral conjunctivitis, bright red tongue with cracked lips, desquamation involving skin on fingertips. Most at risk for?

A

Kawasaki - coronary artery aneurysms (medium sized vessel vasculitis)

66
Q

CXR diffuse thickening and fibrosis of lower lung lobes with formation of fibrocalcific plaques on parietal plerua. Fibers coated with a protein-iron matrix

A

Ferruginous bodies seen in Asbestosis - formation of fibrocalcific plaques on parietal pleura with fibrosis of lower lung lobes

67
Q

How to assess comprehension?

A

Following MULTI-STEP COMMANDS

68
Q

How to asses Attention and Concentration

A

RECITE months or year backwards; Count down from 100 by 7 or 3s, spell world backward

69
Q

How to asses short-term memory

A

Recall 3 unrelated words after 5 minutes

70
Q

Components of MSE

A

Orientation-Comprehension-Concentration-Memory(S/L)-Language-Visual-spacial (Oriental californians Can memorize languages visually)

71
Q

Dysplasia

A

Reversible change in epithelial cells (not reversible once invasive cells breach BM)

72
Q

GnRH, LH, and testosterone levels in a patient with bitemporal hemianopsia

A

Pituitary tumor 605 of time is prolactinoma and PROLACTIN INHIBITS ENTIRE AXIS of GnRH-LH/FSH - sex hormones - causing impotence in men, amenorrhea in women (hypogonadotropic amenorrhea)

73
Q

Grossly, deposits of fine gritty white granules or clumps. HE show deposits that are dark purple, sharp-edged aggregates. Psammoma body if lamellated outer layers

A

DYSTROPHIC CALCIFICATION

74
Q

NORMAL CHEST RADIOGRAPH - SHOW RIGHT ATRIUM - RIGHT VENTRICLE

A

Right border is RA, center is RV, lower left border is LV

75
Q

Microscopic findings: Eosinophilic intranuclear inclusions in multinuclear squamous cells at margins of ulcers (espophageal biopsy of HIV patient)

A

HSV-1

76
Q

Microscopic findings: Both intranuclear and cytoplasmic inclusions from esophageal biopsy of aids patient

A

CMV

77
Q

Arterial blood findings in 32 year old female: PaO2 Normal, 5 Saturation normal, Oxygen content is low

A

Chronic blood loss - total oxygen content is determined by amoung of Hb in blood and its percent saturation

78
Q

Pulsus paradoxus

A

Decreased in systolic BP greater than 10 mmHg with inspiration

79
Q

What causes the decrease in systolic blood pressure during inspiration seen in pulsus paradoxus

A

Expansion of right side of heart imparied and inspiration pushes the IV septum toward the left, left diastolic volume and SV reduced resulting in decreased systemic blood pressure

80
Q

Causes of pulsus paradoxus

A

Acute cardiac tamponade, constrictive pericarditis, severe obstructive lung disease, restrictive cardiomyopathy

81
Q

Bilateral wedge-shaped bands of necrosis over cerebral convexity, just lateral to interhemispheric fissuure

A

ISCHEMIC-HYPOXIC ENCEPHALOPATHY

82
Q

Metabolic alkalosis with urinary chloride <10 mEq/L

A

SALINE-RESPONSIVE metabolic alkalosis - due to vomiting and nasogastric suction losing hydrochloric acid, associated with volume loss and corrected w volume repletion

83
Q

Metabolic alkalosis with urinary chloride >20 mEq/L

A

SALINE-RESISTANT metabolic alkalosis, seen in primary hyperaldosteronism, aldosterone losses K, Cl and H with relative increase in HCO3 resulting from the H losses.

84
Q

High arterial blood pH, HCO3 and pCO2? Major causes?

A

Metabolic alkalosis - vomiting, NG suction, diuretic use or hyperaldosteronism. Measure urinary chloride and volume status to determine cause.

85
Q

Fine-needle aspiration of thyroid nodule shows spindle-shaped cells in amporphous background, elevated calcitonin

A

Medullary thyroid are tumors of parafollicular calcitonin secreting C-cells, 80% are sporadic and 20% familial (MEN2) RET proto-oncogene mutation in >95%!!

86
Q

Vegetations seen in infective endocarditis represent

A

FIBRIN and PLATELET DEPOSITION at the site of acterial colonization

87
Q

Histology seen in giant cell arteritis

A

GRANULOMATOUS INFLAMMATION OF THE MEDIA. Also seen in Takayasu arteritis affecting aortic arch

88
Q

ST elevation in leads I and V3-V6

A

ANTEROLATERAL LEFT VENTRICULAR infarction - LV failure, leading to cardiogenic acute pulmonary edema and transudate of plasma into the lung interstitium and alveoli

89
Q

Hemosiderin-containing macrophages in alveoli

A

(siderophages) suggest prior episodes of pulmonary congestion = CHRONIC LEFT HF

90
Q

Elevated lactic acid in a patient with fever, leukocytosis, hypotension, tachycardia

A

SEPTIC SHOCK

91
Q

Lactic acidosis

A

Anion-gap metabolic acidosis

92
Q

Fever, Leukocytosis + CXR demonstrate dense airspace opacities in the superior region of the lower lobes

A

most consitent with PNEUMONIA (aspiration likely due to superior regions of lower lobes)

93
Q

Name 2 curved motile gram-negative, oxidase positive rods. How do you distinguish the 2?

A

Vibrio cholerae GROWS on ALKALINE enrichment media (that kills most organisms of gut). Campylobacter jejuni CANNOT SURVIVE in ALKALINE enrichement.

94
Q

Outbreak caused by oxidase-positive, gram-negative, comma-shaped rods that can survive on alkaline media.

A

Vibrio cholerae -> Mucus with some epithelial cells in stool (NO leukocytes or RBCs b/c non-invasive)

95
Q

28 year old woman, shortness of breath, hemoptysis, abnormal vaginal bleeding 8 weeks post partum. Enlarged uterus, elevated human chorionic gonadotrophin (beta-hCG). CXR multiple, bilateral lung nodules

A

GESTATIONAL CHORIOCARCINOMA - malignant tumor from trophoblast, usually after evacuated hydatidiform mole. Lungs most common site mets.

96
Q

Histology of gestational choriocarcinoma

A

intrauterine mass that is soft and yellow-white with extesnsive areas of necrosis and hemorrhage. Abnormal proliferation of cytotrophoblasts and syncytiotrophoblasts. No villi.

97
Q

Peaked T waves

A

serum K concentration > 6.0 mEq/L (potential for fatal ventricular arrhythmia)

98
Q

squamous metaplasia of epithelial lining of pancreatic exocrine ducts to a keratinizing epithelium

A

Avitaminosis A

99
Q

Cells with abundant mucin droplets that push the nucleus to one side.

A

SIGNET-RING or DIFFUSE CARINOMA - diffuse involvment of the stomach wall “leather-bottle stomach” linitis plastica

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